Does Smoking by Pregnant Women Influence IQ, Birth Weight, and Developmental Disabilities in Their Infants? A Methodological Review and Multivariate Analysis

Neuropsychologists are asked frequently to address the issue of the cause of a variety of central nervous system problems that may affect higher cortical function. One such issue is the relationship of maternal smoking to adverse reproductive outcomes involving neocortical insult including mental retardation, learning disabilities, attention-deficit hyperactivity disorder, and other insults that may be related to prolonged hypoxic states in utero. The instant paper develops the issue of causation as a scientific inquiry, reviews several traditional, applicable models, and critiques these models. An additional model of motility is proposed and discussed. The issue of the relationship of maternal smoking to adverse reproductive outcomes is then addressed from a review perspective along with new empirical analyses, the latter demonstrating that researchers tend to draw causal conclusions independent of whether the respective design of their studies would support conclusions about the causation of an event. Causal conclusions in the absence of causal designs have often lead to incomplete and incorrect conclusions. It is necessary to match conclusions not only to the outcomes of a research project but also to its design and accompanying limitations.     

Definitional and Research Issues in the Common Factors Approach to Psychotherapy Integration: Misconceptions, Clarifications, and Proposals

This paper focuses on two common misconceptions of common factors in therapy. The first misconception entails the confusion between common factors and therapeutic factors, and thus the inappropriate and misleading use of the term therapeutic common factors in various situations. The second misconception is the mixing of commonalities of different kinds and levels in proposed lists and studies of common factors. These areas are discussed and clarified, and recommendations designed to facilitate conceptual and methodological improvements relative to each misconception are offered. The selection of best levels and kinds of common factors to be studied are further explored (i.e., the study of client change events and antecedent therapist behaviors across different therapies), and specific proposals for their research are outlined.     

Family-Based Therapy for Adolescent Drug Abuse: Knowns and Unknowns

Family-based therapy is one of the most thoroughly studied treatments for adolescent drug abuse. Considerable empirical support exists for the efficacy of family-based therapy in curtailing adolescent drug use and cooccurring behavior problems. This article extends knowledge of the effects of family-based therapy for adolescent drug abuse by reviewing 16 controlled trials and 4 therapy process studies from a treatment development perspective. We articulate knowns and unknowns regarding the outcomes of treatment as well as the components, processes, mechanisms, moderators, and boundaries of effective family-based therapy for adolescent drug abuse. The review highlights areas of progress and future research needs within the specialty of family-based therapy for adolescent drug abuse.     

The Effect of Competitive Outcome and Task-Involving,Ego-Involving,and Cooperative Structures on the Psychological Well-Being of Individuals Engaged in a Co-Ordination Task: A Self-Determination Approach

Differing task and motivational characteristics of the competitive setting (viz., task-involving/ego-involving climates, cooperative/individual, and win/loss competitive outcome) were explored in relation to need satisfaction and subjective well-being (SWB). Participants, one-on-one or in pairs, were required to participate in a physical co-ordination task. Results revealed participants exposed to a task-involving condition and those who worked in cooperation to report higher levels of need satisfaction and SWB. Conversely, individuals exposed to ego-involving conditions and those who competed individually experienced higher levels of negative affect. Winning resulted in higher levels of need satisfaction and SWB, whereas losing led to higher levels of negative affect. Losing individually in an ego-involving condition led to the highest levels of negative affect responses and attenuated levels of reported need satisfaction and SWB. Via structural equation modeling, a model of motivational processes grounded in self-determination theory was supported in which elements of the competitive situation that facilitated need satisfaction led to increments in reported indices of SWB.     

Exposure with response prevention versus habit reversal in Tourettes's syndrome: a controlled study

The intentional nature of tics provides the opportunity to apply behavioural interventions aimed at tic reduction through interruption of stimulus-response sequences. The aim of this study has been to evaluate the effect of exposure and response prevention (ER) versus habit reversal (HR) in 43 Tourette's syndrome (TS) patients. The three outcome measures were: the Yale Global Tic Severity Scale (YGTSS), 15-min tic frequency registrations monitored at the institute and 15-min home tic frequency registrations. Both treatment conditions resulted in statistically significant improvements on all outcome measures (p < 0.001). No significant differences were found between the treatment conditions on any of the outcome measures, although there was a tendency in favour of ER on the YGTSS (p = 0.05). These results suggest that, at least in the short term, TS tic symptoms can be treated effectively with both types of treatment.     

Review of studies evaluating psychotherapy in bulimia nervosa: the influence of research methods

The purpose of the study was to test if design and research methods of studies predict outcome results of bulimia nervosa. Fifty-seven articles on outcome of bulimia nervosa were found through MEDLINE and PSYCHINFO databases and 25 were included in the statistical analysis. Percentages of patients with a good outcome ranged from 24% to 74% with a mean of 51.1%. The variables best predicting outcome were time to follow-up and number of symptoms evaluated in definition of good outcome whereas dropout, design of studies, treatments, and sample characteristics did not predict significantly. The implications of these findings are discussed.     

Active-imaginal exposure: examination of a new behavioral treatment for cynophobia (dog phobia)

The aims of this study were to investigate exposure-based treatments for cynophobia (dog phobia) and to test a newly developed hybrid imaginal exposure treatment that we have named active imaginal exposure. The treatment introduces an in vivo coping component to imaginal exposure whereby the patient physically performs coping responses to an imagined feared stimulus. Eighty-two participants meeting DSM-IV criteria for specific phobia (animal subtype) were randomly assigned to one of three 30-min. treatments: (a) active-imaginal exposure (AI), (b) imaginal exposure alone (IE), or (c) graduated in vivo exposure (IV). Participants completed a behavioral approach test at pre, post, and four-week follow-up. Significant pre- to posttreatment improvement was observed in all three treatment conditions. Response rates at posttreatment were 51.9, 62.1, and 73.1% for the IE, AI, and IV groups respectively. Likewise, effect sizes at posttreatment were 0.76, 1.41, and 1.55 for the IE, AI, and IV groups respectively. Although in the predicted direction, the between group differences were not significant. A similar pattern of results was observed at follow-up. Further, safety behavior utilization during treatment was associated with less improvement--particularly in the two imaginal treatment conditions. Exposure treatments of dog phobia appear feasible and effective in reducing phobic fear and avoidance associated with dog phobia. Furthermore, preliminary evidence suggests that our active-imaginal exposure treatment may be a viable alternative to in vivo exposure.     

An outcome management program for extending advances in choice research into choice opportunities for supported workers with severe multiple disabilities

We evaluated an outcome management program for increasing choice opportunities provided by 2 job coaches for 5 supported workers with severe multiple disabilities in a community job. The program involved specifying and monitoring behavioral outcomes among workers and staff, training staff, and supportive and corrective feedback. Increased choice provision occurred for both job coaches across a 1-year period. Results indicate how outcome management can help translate advances in choice research into routine practice.     

Ethnicity and Social Support During Pregnancy

Data from two multi-ethnic prospective studies of African American, Latina, and non-Hispanic White pregnant women were used to examine the influence of contextual factors on social support processes during pregnancy. Multiple types of support (perceived support, received support, support satisfaction, network support) and sources of support (baby's father, family, friends) were assessed. The role of ethnicity in social support was examined after controlling for the contribution of related contextual factors (SES, marital status, age, parity, employment) to these processes. The impact of ethnicity and related contextual factors differed across sources of social support. Ethnic differences in support from family and friends, but not from the baby's father, emerged. However, marital status was a consistent predictor of support from the baby's father, and SES was a consistent predictor of support from friends. Overall, the findings of two studies suggest that although ethnicity is associated with support from friends and family, other contextual factors, such as marital status and SES, influence support processes during pregnancy.     

The Role of Schools in Outcomes for Youth: Implications for Children's Mental Health Services Research

We explore the role of schools in children's mental health services research. Recent literature has suggested that schools play an important role in delivering services to children and adolescents with emotional and behavioral problems. Research in services research, though, has taken a fairly narrow view of which dimensions of school environments are relevant for inclusion in studies. We suggest that a broader view of school environments is appropriate and potentially beneficial to the field. Using Bronfenbrenner's ecological model as a guide, we conceptualize schools as microsystems. Such an approach suggests that all aspects of school environments (treatment as well as non-treatment) are likely to influence many of the outcomes that children's mental health services research frequently targets (e.g., behavioral problems, problematic peer relationships, academic achievement, school attendance). We review literature from a variety of disciplines to suggest relevant features of schools, with particular attention to the role of peer dynamics within schools. We conclude with implications of this expanded conceptualization of schools for children's mental health services research.